Why treating your hangover is so difficult.
Americans are consuming more alcohol than they used to — and many are feeling it the next morning.
Since the repeal of prohibition, countless public health campaigners have targeted the dangers of drinking. But hangovers have gotten much less attention.
Chris Alford, an associate professor in applied psychology at the University of the West of England, is doing his part to change that.
During a session at the annual scientific meeting of the Research Society on Alcoholism last month, Alford positioned hangovers as a public safety issue and emphasized the importance of finding effective treatment options.
“It isn’t just how you feel,” he told Healthline.
“Yes, you feel really bad — but you’re also impaired,” he said.
In driving simulations, Alford and colleagues have found that hangovers reduce people’s steering control and response time. In fact, his team found levels of impairment among hungover drivers that were comparable to those of drunk drivers.
“Our work shows that if you’re hungover, your driving ability is similar to if you were over the legal limit. But of course, if you were pulled over,” he added, “you’d likely show a blood alcohol reading of zero or close to zero.”
Researchers in Australia have also found that hangovers impair cognitive functioning.
“We’re looking at the cognitive consequences — so looking at people’s problems with concentration, memory, and psychomotor performance — and we’ve shown that those effects are very profound,” Andrew Scholey, PhD, director of the Centre for Human Psychopharmacology at Swinburne University of Technology, told Healthline.
“When you’re in a hangover state, it flattens your cognitive abilities,” he added.
Absenteeism from school and work is another problem associated with hangovers. So is “presenteeism,” which happens when people show up too sick to work.
“There’s not much going on in their heads, and they can’t really do much,” Alford explained, “because they’re so hungover.”
Americans experience an estimated 2.6 billion hangovers every year, Alford told Healthline.
At a basic level, we know those hangovers are the result of alcohol.
But experts don’t know which products of alcohol metabolism, known as metabolites, are responsible for specific symptoms.
“With so little understood about the hangover, it’s quite difficult to target a hangover cure that will work,” Sarah Benson, a postdoctoral research fellow who works with Scholey at Swinburne University of Technology, explained.
“Further research is needed to understand the physiology of the hangover to then be able to form an effective cure,” she added.
One potential culprit is acetaldehyde, a toxin produced in the breakdown of alcohol that causes facial flushing and other symptoms in more than a third of East Asian people.
But researchers have found that hangover symptoms persist after acetaldehyde is no longer present in the body. So, it’s probably not responsible for those symptoms — or at least not solely responsible.
Some symptoms might be chalked up to dehydration, a common consequence of drinking too much alcohol.
Other symptoms might be linked to an immune response involving inflammatory cytokines, a type of inflammation-promoting protein. Those proteins have been found in elevated levels in people with hangovers.
To nail down the causes, researchers at multiple centers around the world have launched studies to track changes in levels of alcohol metabolites and hangover symptoms over time.
For instance, researchers in the Netherlands have been studying water-soluble metabolites in blood and urine. Alford and colleagues plan to assess volatile metabolites in breath.
“It could be that acetaldehyde or other products are kicking off this inflammatory response that carries on afterwards,” Alford suggested.
“You can track the time course of the hangovers and see what metabolites are coming up. Then once you’ve got your biomarkers,” he said, “you can say, what would be the most sensible thing to develop to have a cure?”
Hangover research poses methodological challenges that researchers are still learning to navigate.
“In the laboratory, for ethical reasons, we can’t use the very high levels of alcohol that many people might normally drink on the outside,” Benson explained.
“So, to get around that, we’d normally have people go out overnight for their typical drinking and then have them come into the lab the following morning,” she said.
This makes it tricky to assess participants’ peak blood alcohol content.
Differences between individual participants can also make it harder to identify the causes of hangover symptoms.
“We’ve got different genetic makeups that can affect how we respond to alcohol. We know, for example, that some people are far more sensitive to alcohol,” Alford explained. “They don’t have the same amount of the enzyme, alcohol dehydrogenase, that breaks it down. Some people are super metabolizers, so they break it down faster.”
Some people are also sensitive to substances produced during alcoholic fermentation, such as tannins in red wine.
Differences in behavior, including sleep, exercise, eating, and smoking may also affect how someone feels after a night of heavy drinking.
The most reliable way to avoid a hangover is to drink in moderation or abstain from alcohol entirely.
When symptoms of a hangover do hit, there are some basic treatment options available that might help.
“The standard ones at the moment are over-the-counter products that include things like aspirin or ibuprofen, often in combination with caffeine, which will help perk you up a bit,” Alford said.
Electrolyte-enhanced beverages, such as Pedialyte and Gatorade, can help alleviate dehydration. On the more extreme side of things, a company in Chicago markets IV hydration therapy for $159 per hangover treatment.
Some herbal remedies and supplements, such as borage and tolfenamic acid, have also shown promise for preventing or relieving certain symptoms.
However, relatively few studies have systematically evaluated the effectiveness of hangover treatments.
Moreover, none of the treatments currently available have been shown to alleviate all of the symptoms of hangover, including functional impairments.
Alford said that more research on current and potential treatments options is warranted. But more than that, he hopes that researchers can one day find a way to “cure” a hangover.
“At the moment, we can help with some of the symptoms. The next step, when we know what the key metabolites are, is to begin to look for a cure,” he said.
In the meantime, he emphasized the importance of raising awareness about the risks of driving and working while hungover.
“If you’re going to a party, have someone help drive you the next day,” he recommended, “and maybe imagine that you’re still over the limit.”